Author:
Suárez José Francisco,Zamora Víctor,Garin Olatz,Gutiérrez Cristina,Pont Àngels,Pardo Yolanda,Goñi Alai,Mariño Alfonso,Hervás Asunción,Herruzo Ismael,Cabrera Patricia,Sancho Gemma,Ponce de León Javier,Macías Víctor,Guedea Ferran,Vigués Francesc,Castells Manuel,Ferrer Montse,Ferrer Montse,Garin Olatz,Pont Àngels,Pardo Yolanda,Alonso Jordi,Zamora Víctor,Guedea Ferran,Ventura Montse,Gutiérrez Cristina,Ferrer Ferran,Boladeras Ana,Suárez José Francisco,Castells Manel,Bonet Xavier,Ávila Mónica,Pastor Sergi,Bonet Carmen,Sancho Gemma,Ponce de León Javier,Palou Joan,de Paula Belén,Goñi Alai,Fernández Pablo,Herruzo Ismael,Hervás Asunción,Ramos Alfredo,Macías Víctor,Solé Josep,Bonet Marta,Mariño Alfonso,Cabrera Patricia,Ortiz María José,
Abstract
AbstractTo compare the effectiveness at ten years of follow-up of radical prostatectomy, brachytherapy and external radiotherapy, in terms of overall survival, prostate cancer-specific mortality and biochemical recurrence. Cohort of men diagnosed with localized prostate cancer (T1/T2 and low/intermediate risk) from ten Spanish hospitals, followed for 10 years. The treatment selection was decided jointly by patients and physicians. Of 704 participants, 192 were treated with open radical retropubic prostatectomy, 317 with 125I brachytherapy alone, and 195 with 3D external beam radiation. We evaluated overall survival, prostate cancer-specific mortality, and biochemical recurrence. Kaplan–Meier estimators were plotted, and Cox proportional-hazards regression models were constructed to estimate hazard ratios (HR), adjusted by propensity scores. Of the 704 participants, 542 patients were alive ten years after treatment, and a total of 13 patients have been lost during follow-up. After adjusting by propensity score and Gleason score, brachytherapy and external radiotherapy were not associated with decreased 10-year overall survival (aHR = 1.36, p = 0.292 and aHR = 1.44, p = 0.222), but presented higher biochemical recurrence (aHR = 1.93, p = 0.004 and aHR = 2.56, p < 0.001) than radical prostatectomy at ten years of follow-up. Higher prostate cancer-specific mortality was also observed in external radiotherapy (aHR = 9.37, p = 0.015). Novel long-term results are provided on the effectiveness of brachytherapy to control localized prostate cancer ten years after treatment, compared to radical prostatectomy and external radiotherapy, presenting high overall survival, similarly to radical prostatectomy, but higher risk of biochemical progression. These findings provide valuable information to facilitate shared clinical decision-making.Study identifier at ClinicalTrials.gov: NCT01492751.
Funder
Instituto de Salud Carlos III
Generalitat de Catalunya
Publisher
Springer Science and Business Media LLC